Biomedical subjects

John Deluca

Publications and source records attributed to John Deluca.

11 recordsLinked to original sources

PubMed2007

Paclitaxel plus Ifosfamide followed by high-dose carboplatin plus etoposide in previously treated germ cell tumors.

PURPOSE: To evaluate the optimal dose of carboplatin as well as the efficacy and tolerability of sequential, dose-intense chemotherapy with paclitaxel and ifosfamide followed by carboplatin and etoposide (TICE) plus peripheral-blood stem-cell (PBSC) support in patients with germ cell tumors (GCT) who are likely to experience treatment failure with conventional-dose salvage treatment. This prospective trial followed a similarly designed report of TICE, which used a different means of carboplatin dosing. PATIENTS AND METHODS: The 48 patients entered onto this trial had progressive GCT and unfavorable prognostic features after chemotherapy. Two cycles of paclitaxel plus ifosfamide were administered with leukapheresis, followed by three cycles of carboplatin plus etoposide with reinfusion of PBSC. RESULTS: Twenty-three (49%) of 47 assessable patients achieved a complete response (CR) to chemotherapy. An additional three patients (6%) achieved a CR to chemotherapy and surgery. The CR rate was 55%. Six patients experienced relapse, but 24 patients (51%) are alive and free of disease at a median follow-up time of 40 months. Four patients who experienced relapse or achieved an incomplete response were rendered disease free by salvage surgical resection. When combined with results of the prior trial of similar design, TICE chemotherapy yielded an overall CR of 56% (n = 84), with 50% of patients alive with no evidence of disease. CONCLUSION: TICE is an effective and tolerable dose-intense treatment for patients with previously treated metastatic GCT who have a poor predicted outcome to conventional-dose salvage chemotherapy.

Adolescent↗

PubMed2007

Functional outcomes from inpatient rehabilitation after traumatic brain injury: how do Hispanics fare?

OBJECTIVE: To examine the relation between Hispanic ethnicity and rehabilitation outcome in traumatic brain injury (TBI) survivors. DESIGN: Retrospective study. SETTING: Longitudinal dataset of the Traumatic Brain Injury Model Systems national database. PARTICIPANTS: Persons (N=3056; 2745 whites vs 311 Hispanics) with moderate to severe TBI hospitalized between 1989 and 2003. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional outcomes at discharge and 1-year follow-up (Disability Rating Scale [DRS], FIM instrument). Glasgow Outcome Scale-Extended (GOS-E), and the Community Integration Questionnaire (CIQ) were measured at follow-up only. RESULTS: At admission, Hispanics were less educated (P</=.001), earned less money (P</=.05), and were younger (P</=.001) than whites. Hispanics had lower GOS-E scores (P</=.01) at acute hospital admission compared with whites. Despite similar functional status at inpatient rehabilitation discharge, Hispanic ethnicity was associated with poorer functional outcomes at 1 year postinjury (DRS, FIM, CIQ), after controlling for age, length of posttraumatic amnesia, injury severity, DRS score at admission, FIM score at admission, and preinjury educational level (P<.05). CONCLUSIONS: Hispanics showed significantly reduced long-term functional outcome after rehabilitation relative to whites. Rehabilitation professionals should recognize the possible impact of individual differences and diverse sociodemographic, injury, and rehabilitation characteristics so that differential health outcomes among TBI survivors can be reduced or eliminated.

Activities of Daily Living↗

PubMed2005

Cortical and subcortical diseases: do true neuropsychological differences exist?

Previous work examining the cortical-subcortical distinction as it relates to cognitive patterns has not typically used genetic confirmation to identify these groups, controlled for age, or used a comprehensive battery to assess specific cognitive abilities. The present study is the first to include only genetically confirmed Familial Alzheimer's disease (FAD) and Huntington's disease (HD) patients to evaluate this distinction. Ten patients with FAD, 11 patients with HD, and 17 matched healthy individuals were compared on a comprehensive neuropsychological battery that included tasks of language, memory, attention, visual-spatial, and executive function. The only neuropsychological measures to differentiate the two clinical groups were Animal Fluency and Letter Fluency; performance on all other measures did not differ. Although the neuropsychological battery adequately distinguished between clinical and healthy individuals, it was not useful to further differentiate the cortical or subcortical nature of the disease. FAD and HD appear to have similar neuropsychological profiles; therefore the cortical versus subcortical cognitive distinction may not be clinically meaningful.

Adult↗

PubMed2005

A trial of neuropsychologic rehabilitation in mild-spectrum traumatic brain injury.

OBJECTIVE: To test the effectiveness of a neuropsychologic rehabilitation program consisting of psychotherapy and cognitive remediation in the treatment of the affective and neuropsychologic sequelae of mild-spectrum traumatic brain injury (TBI). DESIGN: Single-blind randomized, wait-listed controlled trial, with repeated measures and multiple baselines. SETTING: Outpatient clinic in northern New Jersey. PARTICIPANTS: Twenty persons with persisting complaints after mild and moderate TBI (11 in treatment group, 9 controls). INTERVENTIONS: The experimental group received both 50 minutes of individual cognitive-behavioral psychotherapy and 50 minutes of individual cognitive remediation, 3 times a week for 11 weeks. The control group was wait-listed and received treatment after conclusion of follow-up. MAIN OUTCOME MEASURES: Symptom Check List-90R General Symptom Index, plus scales of depression, anxiety, coping, attention, and neuropsychologic functioning. RESULTS: Compared with the control group, the treatment group showed significantly improved emotional functioning, including lessened anxiety and depression. Most significant improvements in emotional distress were noted at 1 month and 3 months posttreatment. Performance on a measure of divided auditory attention also improved, but no changes were noted in community integration scores. CONCLUSIONS: Cognitive behavioral psychotherapy and cognitive remediation appear to diminish psychologic distress and improve cognitive functioning among community-living persons with mild and moderate TBI.

Adult↗

PubMed2004

Differential cerebellar activation on functional magnetic resonance imaging during working memory performance in persons with multiple sclerosis.

OBJECTIVE: To explore the potential role of the cerebellum in working memory dysfunction in multiple sclerosis (MS). DESIGN: Blood oxygen level dependent functional magnetic resonance imaging (fMRI) was used to examine cerebellar activation during a working memory task. SETTING: University-affiliated medical rehabilitation facility. PARTICIPANTS: Eight persons with MS and 5 healthy controls. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Change in hemodynamic response. fMRI data were acquired and subsequently analyzed by using Statistical Parametric Mapping. RESULTS: Both the control and MS groups showed significantly greater activations in the right cerebellar hemisphere as compared with the left side. Persons with MS, however, showed no detectable activations in 4 cerebellar substructures that were significantly active in controls (ie, right vermis, right dentate nucleus, right tonsil, cerebellar peduncle). CONCLUSIONS: The significantly decreased cerebellar activation in the MS group suggests that the cerebellum may play a role in the working memory impairment observed in MS.

Adolescent↗

PubMed2004

Working memory deficits in chronic fatigue syndrome: differentiating between speed and accuracy of information processing.

To examine the relative influence of speed of information processing versus working memory ability, CFS participants with psychiatric comorbidity (CFS-Psych) and CFS without a psychiatric history (CFS-noPsych) were examined on tests of visual and auditory processing speed and visual and auditory working memory. Compared to healthy controls (HC) and a group of participants with rheumatoid arthritis (RA), the CFS-noPsych group displayed significantly reduced performance on tests of information processing speed, but not on tests of working memory. No significant differences were observed between the CFS-Psych group and any other group in the study. The implications of group heterogeneity on the understanding of cognitive impairment in CFS are discussed.

Adult↗

PubMed2004

Neuropsychological deficits in patients with chronic fatigue syndrome.

The degree of neuropsychological dysfunction across multiple domains was examined in individuals suffering from chronic fatigue syndrome (CFS). In this descriptive study, a similar series of neuropsychological tests was administered to a group of CFS patients and healthy participants. More specifically, CFS patients (n = 141) who met the 1994 Case Definition criteria were compared to 76 healthy control participants on tests of memory, attention (concentration), speed of information processing, motor speed, and executive functioning. On the 18 measures administered, CFS patients scored 1 standard deviation below the healthy mean on nine measures and scored 2 standard deviations below the healthy mean on four of the measures. Moreover, results indicated that CFS patients were more likely than healthy controls to fail (1.6 SD below the healthy mean) at least one test in each of the following domains: attention, speed of information processing, and motor speed, but not on measures of memory and executive functioning. Finally, CFS patients demonstrated a greater total number of tests failed across domains.

Adult↗

PubMed2003

Functional status, neuropsychological functioning, and mood in chronic fatigue syndrome (CFS): relationship to psychiatric disorder.

Individuals with chronic fatigue syndrome (CFS) face chronic physical debilitation, reduced neuropsychological functioning, and changes in emotional well-being that significantly detract from quality of life. The role of psychiatric disturbance in reducing quality of life in CFS remains unclear. In the current investigation, the role of psychiatric status in reducing health-related quality of life in CFS was examined. Four subject groups were compared on measures of functional well-being, mood, and neuropsychological status: individuals with CFS and no history of psychiatric illness, individuals who had current symptoms of psychiatric illness that began after their CFS diagnosis, individuals who had current symptoms of psychiatric illness that began before their CFS diagnosis, and a healthy sedentary control group. Overall, it was found that individuals with CFS suffer from profound physical impairment. Concurrent psychiatric illness, however, did not adversely affect physical functional capacity. Physical functional capacity was not worse in individuals with a concurrent psychiatric illness. As expected, concurrent psychiatric illness was found to reduce emotional well-being. Moreover, individuals with a psychiatric illness that predated the onset of CFS suffered the greatest emotional distress. Thus, an individual's psychiatric history should be considered when attempting to understand the factors maintaining disability in CFS.

Adaptation, Psychological↗

PubMed2002

Self-generation as a means of maximizing learning in multiple sclerosis: an application of the generation effect.

OBJECTIVE: To examine the generation effect, the observation that items generated by subjects are better remembered than items provided, as a means of maximizing new learning in multiple sclerosis (MS). DESIGN: Prospective between-group design. SETTING: Private, nonprofit research facility. PARTICIPANTS: Population-based sample of 31 subjects with MS (MS group) and 17 healthy controls (control group), matched for age and education. INTERVENTION: Immediate, thirty-minute and 1-week assessments. MAIN OUTCOME MEASURES: Neuropsychologic tests assessing language, executive functioning, working memory, long-term memory, and the generation effect were administered. Recall and recognition of generation effect stimuli was tested immediately, 30 minutes, and 1-week after presentation. RESULTS: Recall and recognition of generated stimuli were significantly higher than provided stimuli across testing sessions. This effect was observed equally across the control and MS groups. Recall performance for generated stimuli correlated significantly with indices of episodic memory, information processing, and language but not executive control. Memory for the source of the information was deficient for generated words compared with provided words. CONCLUSIONS: The generation effect was present in MS and control subjects and may be a viable way of maximizing new learning in MS.

Adult↗

PubMed2002

Assessing functional status: exploring the relationship between the multiple sclerosis functional composite and driving.

OBJECTIVE: To explore the relationship between the Multiple Sclerosis Functional Composite (MSFC), which is comprised of 3 clinical dimensions (arm and hand function, leg function and ambulation, cognition), and an everyday functional skill, driving performance. DESIGN: Cohort study. SETTING: Medical rehabilitation research organization. PARTICIPANTS: Twenty-nine individuals with documented multiple sclerosis (MS) and limited motor decrements. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Driving-related skills were measured by using the overall category rating from the Useful Field of View (UFOV) Test, its 3 subtests, the error and latency scores from the Neurocognitive Driving Test (NDT), subjective (self-report) and objective (Department of Motor Vehicles [DMV] reports) reported driving experience, and number of motor vehicle crashes. Within the group, differences were explored between participants rated as low risk versus moderate-high risk on the UFOV overall score and between participants who reported a change in driving habits after MS versus those who reported no change. RESULTS: The overall MSFC score correlated significantly with the UFOV overall score, the visual-information processing and selective attention subtests of the UFOV, the NDT latency score, as well as with the number of days a week the individual drove and the number of crashes reported by the DMV. An examination of the MSFC components revealed that the cognition component was significantly related to the UFOV overall score, all 3 subtests of the UFOV, and the NDT latency score. The arm and hand function component correlated significantly with NDT latency and the selective attention subtest of the UFOV. Individuals classified as low risk on the UFOV overall had more education, better MSFC scores, and lower NDT latency scores. Only the overall MSFC score distinguished those who reported a change in driving habits after onset of MS. CONCLUSIONS: Problems with everyday functional skills such as driving are accurately identified through the use of the overall MSFC and its components.

Adult↗

PubMed2002

Motor vehicle crashes and violations among drivers with multiple sclerosis.

OBJECTIVE: To investigate differences in the incidence of motor vehicle crashes (MVCs) and violations among drivers with multiple sclerosis (MS) when cognitive impairment is present. DESIGN: Archival evaluation of Department of Motor Vehicles (DMV) records. SETTING: Medical rehabilitation research organization. PARTICIPANTS: Community-dwelling drivers, 27 subjects with documented MS (14 MS without cognitive impairment [MS-], 13 MS with cognitive impairment [MS+]) and 17 healthy control subjects, matched on age, sex, and driving experience. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Incidence of MVCs and motor vehicle violations as documented by DMV reports for the past 5 years. RESULTS: MS+ subjects showed a higher incidence of MVCs when compared with control and MS- subjects. No significant difference in the incidence of motor vehicle violations was observed between groups. CONCLUSIONS: The presence of cognitive impairment in drivers with MS can result in an increased risk of MVC involvement.

Accidents, Traffic↗